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Purpose: To compare the effectiveness and safety of cefazolin versus cloxacillin for the treatment of infective endocarditis (IE) due to methicillin-sensitive Staphylococci (MSS)., Methods: Data were retrospectively collected on patients treated for a definite MSS endocarditis who received cefazolin or cloxacillin for at least 10 consecutive days in six French hospitals between January-1 2014 and December-31 2020. The primary endpoint was treatment failure defined as a composite of death within 90 days of starting antibiotherapy, or embolic event during antibiotherapy, or relapse of IE within 90 days of stopping antibiotherapy. We used Cox regression adjusted for the inverse probability of treatment weighting of receiving cefazolin., Results: 192 patients were included (median age 67.8 years). IE was caused by S.aureus in 175 (91.1%) and by coagulase-negative staphylococci in 17 (8.9%). Ninety-four patients (48.9%) received cefazolin, and 98 (51%) received cloxacillin. 34 patients (34.7%) with cefazolin and 26 (27.7%) with cloxacillin met the composite primary endpoint, with no significant differences between groups (adjusted HR = 1.13, 95% CI 0.63 to 2.03). There were no significant differences in secondary efficacy endpoints or biological safety events., Conclusion: The effectiveness of cefazolin did not significantly differ from cloxacillin for the treatment of MSS endocarditis., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Streptococci involved in infective endocarditis (IE) primarily comprise alpha- or non-hemolytic streptococci (ANHS). Moreover, beta-hemolytic streptococci (BHS) can be involved, and guidelines recommend the addition of gentamicin for the first 2 weeks of treatment and the consideration of early surgery in such cases. This study compared the morbidity and mortality associated with IE depending on the microorganisms involved (BHS, ANHS, staphylococci, and enterococci)., Methods: We conducted a retrospective observational study between 2012 and 2017 in a single hospital in France. The endpoints were overall in-hospital mortality, 1-year mortality and the occurrence of complications., Results: We analyzed 316 episodes of definite IE including 150 (38%), 96 (25%), 46 (12%), and 24 cases (6%) of staphylococcal, ANHS, enterococcal, and BHS IE, respectively. In-hospital mortality was significantly higher in the staphylococcal (n = 40; 26.7%) and BHS groups (n = 6; 25.0%) than in the ANHS (n = 9; 9.4%) and enterococcal groups (n = 5; 10.9%) (all p < 0.01). The rates of septic shock and cerebral emboli were also higher in the BHS group than in the ANHS group [n = 7 (29.2%) vs. n = 3 (3.1%), p < 0.001; n = 7 (29.2%) vs. n = 12 (12.5%); p = 0.05, respectively]., Conclusion: This study confirmed that BHS IE has a more severe prognosis than ANHS IE. The virulence of BHS may be similar to that of staphylococci, justifying increased monitoring of these patients and more 'aggressive' treatments such as early surgery.

Background: Listeria monocytogenes-associated endovascular infections are not well characterized., Methods: Retrospective study of 71 culture-proven cases reported to the French National Reference Center for Listeria from 1993 to 2018., Results: Seventy-one cases were identified: 42 with vascular aneurysms/prosthetic infections, 27 with endocarditis, 2 with both. Fifty-eight were men (82%); median age was 75 years [46-92]; 93% reported co-morbidities (66/71), including 50% with immunosuppressive conditions. Vascular infections consisted of infected aneurysms (68%) or prosthetic graft infections (32%); vascular rupture was reported in 25/42 (60%). Tissue samples grew L. monocytogenes in 98% (43/44) and blood cultures in 64% (27/42). Endocarditis cases involved prosthetic or native valves or intracardiac devices in respectively 62% (18/29), 28% (8/29) and 10% (3/29). Infected valves were aortic (62%, 16/26), mitral (31%, 8/26) or both (8%, 2/26); 38% patients required surgery; 45% displayed heart failure; 17% had concomitant neurolisteriosis. In-hospital mortality in vascular infections was 12% (5/42) and 41% (12/29) for Lm-associated endocarditis., Conclusions: Endovascular listeriosis is a rare but severe infection. It manifests as vascular infections and endocarditis, mostly in older patients with vascular or cardiac valve prosthetic devices and co-morbidities. Mortality in Lm-associated endocarditis is twice higher than with other pathogens, requiring prompt recognition and treatment., (Copyright © 2019. Published by Elsevier Ltd.)

Background: Data on infectious endocarditis (IE) in patients with liver cirrhosis (LC) are sparse. We aimed to describe the characteristics and predictors of mortality from IE in patients with LC., Patients and Methods: Overall, 101 patients with LC and 101 controls with IE matched for sex, age, date of IE, and diabetes were retrospectively selected in 23 liver units between 2000 and 2013., Results: Mean age was 60.8±10.5 and 60.6±11.5 years in LC and controls, respectively. Causes of cirrhosis (Child-Pugh A/B/C: 10.4%/41.7%/47.9%, MELD score: 17±7.8) were excess alcohol intake (79.6%), viral hepatitis (17.3%), and metabolic syndrome (14.3%). Previous history of cardiopathy was found in 24.8% of LC (prosthetic valve 8.9%) and 37.6% of controls (P=0.07). The most frequent bacteria involved were gram-positive cocci. LC had significantly fewer aminoglycosides (P=0.0007), rifamycin (P=0.03), and valve surgery (P=0.02) than controls. The proportion of patients who died following cardiac surgery was similar between the two groups (9.7% for LC vs. 8.7% for controls, P=1). In-hospital mortality for Child-Pugh C patients was significantly higher than controls (61.4 vs. 23%, P<0.001), but not for Child-Pugh A (33.3%) or B patients (25.0%). A Child-Pugh score of above C10 was the best predictor of in-hospital mortality. In LC, Child-Pugh score (odds ratio=1.5; 95% confidence interval: 1.2-2.0; P=0.002) and history of decompensation (odds ratio=3.1; 95% confidence interval: 1.1-9.0; P=0.003) were independent predictive factors for in-hospital mortality., Conclusion: Severe liver failure but not cirrhosis is the strongest predictive factor of mortality related to IE in LC. Use of aminosides and rifamycin should be reassessed in LC, and cardiac surgery should be considered for selected patients.

Objectives: To update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE)., Methods: All consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France., Results: SAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%)., Conclusion: SAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.

Objective: Whether sex-related differences in the prognosis of infective endocarditis (IE) are due to differences in disease severity or comorbid patterns, physiological specificities or a treatment indication bias is unclear. We conducted an analysis of the pooled database of two population-based cohorts of IE to reassess the relationships between sex, early valve surgery (EVS) and outcome in patients with IE., Methods: Demographic and baseline characteristics, complications and outcome were compared in men and women with Duke-definite left-sided IE. A propensity model for EVS was constructed using multivariate logistic regression. Factors associated with 1-year mortality were identified using multivariate Cox models adjusted for EVS factors., Results: The study population included 466 (75%) men and 154 (25%) women. Compared with men, women were older (p=0.005), were more often on haemodialysis (p=0.04), more often had a mitral valve IE (50.0% vs 35.8%, p=0.02), less often developed a septic shock (p=0.05), less often underwent EVS (p=0.001) yet had comparable inhospital mortality rates (20.1% vs 20.0%, p=0.96) and similar 1-year survival probability (logrank p=0.68). Female sex was neither associated with EVS (OR 0.76 (95% CI 0.49 to 1.16)) nor mortality (HR 1.17 (95% CI 0.80 to 1.69)). However EVS was associated with an increased risk of death in women in the early postoperative period (HR 8.72 (95% CI 3.42 to 22.24), p=<0.0001)., Conclusions: Women underwent EVS less often than men. However female sex was independently associated with neither EVS nor 1-year mortality. The reasons for a higher risk of early postoperative mortality in women must still be elucidated., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: To assess long-term outcomes and predictors of mortality in patients treated according to current recommendations for cardiac implantable electronic device (CIED) infection., Design: Two-group matched cohort study., Setting: Tertiary-care institution., Patients: Consecutive patients admitted for CIED infection between 2004 and 2008 were prospectively enrolled. Study subjects were matched to a cohort of uninfected CIED patients by age, sex and type of device., Interventions: In all infected patients, the therapeutic approach consisted of complete hardware removal whenever possible, antimicrobial therapy, and implantation of a new device, if indicated. Patients were systematically followed, with standardised outcomes assessment., Main Outcome Measures: All-cause mortality and predictors of long-term mortality., Results: 197 patients were included and matched 1:1 to controls. Pocket infections were present in 41.1% and definite or suspected infective endocarditis in 58.9%. Total or subtotal hardware removal was achieved in 98.5% of cases. Median follow up was 25 months (12-70). Mortality rates in the study group and controls were 14.3% vs 11.0% (NS) at 1 year and 35.4% vs 27.0% (p=NS) at 5 years. Independent predictors of long-term mortality were older age (HR=1.09, p<0.001), cardiac resynchronisation therapy (HR=3.70, p=0.001), thrombocytopenia (HR=5.10, p=0.003) and renal insufficiency (HR=2.66, p=0.006). In patients with reimplanted devices, epicardial right ventricular pacemakers were associated with higher mortality (HR=2.85, p=0.034)., Conclusion: In patients with CIED infection managed by recommended therapy, long-term mortality rates are similar to comparable controls. Independent predictors include patient and disease-related factors, in addition to implantation of right ventricular epicardial pacemakers.

In industrialized countries, after the eradication of rheumatic fever, rheumatic valve diseases progressively disappeared and the proportion of post-rheumatic infective endocarditis significantly decreased. Intravenous drug use, prosthetic valves, age-related degenerative valve sclerosis, and invasive procedures have become the most important risk factors for infective endocarditis. These changes resulted in a decreased incidence of streptococcal endocarditis and an increased incidence of staphylococcal endocarditis.

Background and Aim of the Study: The study aim was to describe the characteristics and operative mortality of patients requiring valve surgery during active infective endocarditis (IE)., Methods: This retrospective analysis involved 141 surgically treated patients with active IE. All cardiac operations were performed by the same surgical team between January 1998 and July 2009. All patients had definite (n = 128) or possible (n = 13) endocarditis according to modified Duke criteria. The IE was considered active if surgery was required before completion of a standard course of antimicrobial therapy. Operative mortality included any death occurring within the same hospital admission as surgery., Results: Among the patients (108 males, 33 females; mean age 56.3 +/- 14.9 years), native valve endocarditis was present in 122 cases (87%). Multiple valve involvement was observed in 27 patients. The infected valves were the aortic (n = 81), mitral (n = 70), tricuspid (n = 15), or pulmonary (n = 2). The most common pathogens were staphylococci (n = 49), streptococci (n = 46) and enterococci (n = 27). The operative mortality was 16%. In univariate analysis, factors linked to operative mortality were age, prosthetic valve endocarditis (PVE) and inadequate antimicrobial therapy. In multivariate analysis, only PVE was an independent adverse predictor (adjusted Odds Ratio = 4.16; 95% confidence intervals 1.14-12.2; p = 0.01)., Conclusion: Surgery for active IE is associated with a high mortality rate. The prognosis is impaired in patients with PVE, but might be improved by adequate antimicrobial therapy.

Aims: To analyse the risk of death according to the type of cerebrovascular complications (CVC) during infective endocarditis (IE) and to analyse the determinants of outcome in patients with IE and a CVC., Methods and Results: In two referral centres, 496 consecutive patients with definite IE were prospectively included. Cerebral CT scan was performed in 453 patients. During a mean 2.9 year follow-up, 139 (28%) patients died and CVC occurred in 109 (22%) patients. Stroke was an independent predictor of death, although no significant excess mortality was observed in patients with silent CVC or transient ischaemic attack (TIA). Among CVC patients, mortality was predicted by the presence of a mechanical prosthetic valve IE and a low Glasgow Coma Scale. When valvular surgery was performed in patients after CVC, neurologic exacerbation was rare [4 (6.3%) patients] and was observed only in patients with symptomatic stroke. Among CVC patients, survival was better in operated patients when compared with patients treated conservatively despite theoretical indication for surgery (P < 0.0001). However, the latter group had more comorbidities (P = 0.007) and a lower Glasgow Coma Scale (14.6 +/- 1 vs. 12 +/- 4, P < 0.0001)., Conclusion: Patients with silent CVC or TIA have a relatively good prognosis, whereas those with stroke have significant excess mortality particularly in case of mechanical prosthetic valve IE or impaired consciousness. Valvular surgery can be safely performed after silent CVC or TIA and may improve survival in selected patients with stroke.

Background: Propionibacterium acnes, a gram positive, anaerobic, skin commensal bacillus, is too often considered a biologic fluid contaminant, of blood cultures in particular. Its implication has been shown in various infections, including brain abscess, ocular infections, osteitis, and acne. It is also the cause of infective endocarditis (IE)., Methods: Retrospective, observational study of 11 patients with P. acnes IE, hospitalised between 1993 and 2001 at the Louis Pradel Hospital, Lyon-Bron, and review of 20 published cases., Results: P. acnes IE is rare, though its prevalence is probably underestimated. It is most likely to affect men (71%), and affects all ages (children 4/31 cases). An entry point, probably cutaneous, is rarely confirmed. P. acnes IE often develops on valve prosthesis (42%), and embolisms are common (61%). The infective site is usually aortic (55%). The often-subtle symptoms and slow growth of the organism in vitro complicate the diagnosis, which is often made at a late stage, when valvular and peri-valvular destruction has become major. Despite the high sensitivity of P. acnes to most antimicrobials, a surgical intervention is very often needed (81%). The mortality is relatively high (15% to 27%). Examination of pathologic specimens by polymerase chain reaction increases the sensitivity and speed of its detection. The identification of P. acnes in a biologic specimen, valvular tissue in particular, requires a thorough knowledge of the clinical context before concluding to contamination, and mandates close surveillance of the patient. P. acnes can be the cause of IE long before it has been detected.

Objective: To demonstrate the effectiveness of the Charlson weighted index of comorbidity (WIC) for controlling comorbidity in prospective studies focusing on mortality in patients with Staphylococcus aureus bacteremia (SAB)., Design: Cohort study., Setting: Two tertiary-care, university-affiliated hospitals in France., Patients: One hundred sixty-six inpatients 18 years or older consecutively diagnosed with SAB from May 15, 2001, to May 15, 2002., Methods: Patients were prospectively assessed and cases were followed by the infectious diseases consult service at least 3 months after effective antibiotic therapy completion. The Charlson WIC was computed and dichotomized into scores of fewer than 3 points and 3 or more points. Bacteremia source, acute complication due to SAB acquisition in the ICU, and inappropriate empiric antibiotic therapy were recorded. The endpoint was death due to SAB and overall mortality., Results: In univariate analysis, the Charlson WIC was able to predict overall mortality and S. aureus-related death. The following variables were found to be independently predictive of mortality due to SAB using the Cox model: an acute complication due to S. aureus (OR, 8.9; CI95, 4 to 19.7; P < .001), a Charlson WIC score of 3 or more (OR, 3; CI95, 1.3 to 5.5; P = .006), and age (OR, 1.04; CI95, 1.009 to 1.07; P < .01)., Conclusions: Comorbidity contributes to death in patients with SAB. The Charlson WIC is a good predictor of mortality in this population and may be a useful instrument to control comorbidity in studies aiming to investigate risk factors for death due to bacteremia.

Objective: We wanted to describe the epidemiological aspects of infective endocarditis (IE) in a French hospital and identify the prognostic factors., Methods: We reviewed the clinical, echocardiographic and microbiological features, and the outcome of 89 patients (90 episodes, median age 60 years) with IE over 18 months. Logistic regression analysis was used to identify prognostic factors for death., Results: A native valve was involved in 68 cases (75.5%); in 7 of these the patient was an intravenous drug user. A prosthetic valve was involved in 22 cases (24.5%); 5 of these were of early onset. Diagnosis was definite in 87% of cases. Median time to diagnosis was 3 days. Twenty-five patients (28%) were immunocompromised. A portal of entry, usually cutaneous, was identified in 65% of cases. Sixty-two percent of patients had an underlying heart disorder, usually degenerative. The infection involved the left heart in more than 75% of cases. One or more vegetations were detected in 75% of cases. The median size of vegetation was 15 mm. Isolated agents were mainly staphylococci (n=40 (44%), including 12 coagulase-negative isolates), and streptococci (n=23 (25%), including 7 enterococci). In 11 cases (12%), cultures remained negative. Nineteen episodes were nosocomial and Staphylococcus aureus was implicated in 11 of them. Fifty percent of patients had at least one complication: heart failure (n=42), kidney failure (n=44), embolism (n=35), septic shock (n=19). Surgery was performed in 49 cases (54%) due to heart failure (n=19), cerebral embolism (n=12), and/or severe valve lesions (n=27). Eighteen patients died, 10 of whom were infected with S. aureus. Nosocomial IE (P=0.0008), heart failure (P=0.004) and prosthetic valve (P=0.01), but not S. aureus were independently associated with death., Conclusions: S. aureus was the main microorganism isolated in our patients. However, it was not independently predictive of fatal outcome.

The incidence of infective endocarditis (20 to 160 cases per million inhabitants yearly) increases with age; it does not seem to be decreasing over time. There is no previously known heart disease in 30% of the patients, a native valve disease in 30 to 60%, a prosthetic valve in 15-20%. Streptococci remain the leading microorganisms. Digestive streptococci and staphylococci are increasing. Iatrogenic portals of entry are in progression. During the hospital stay, case fatality ratio varies from 13 to 20%. After endocarditis, the patient remains at risk of late cardiac surgery and of recurrence. Survival after 5 years is approximately 85%.

Background: Investigators in Lyon, France reported long-term outcome of 330 patients with infective endocarditis (IE). This article compares experience of the cohort to what would be expected in the general population., Results: Excess mortality persisted for many years following IE. Average annual mortality ratios were highest in the first and second years (4050% and 662%, respectively) and decreased gradually thereafter to a low of 219% during duration 10-12 years. Morbidity risk following IE would also be increased because of greater likelihood of recurrent IE, heart failure, embolism, valve thrombosis, additional valve surgery, complications of anticoagulant therapy, and stroke., Conclusions: Morbidity and mortality risk remain elevated for many years following recovery from IE.

Fifty-three patients (42 men; 11 women) with Streptococcus bovis infective endocarditis attended a tertiary cardiology hospital between 1980 and 1991, and constituted 11% of the total number of infective endocarditis cases hospitalized there during that period. The mean age was 59 +/- 15 years; 15 had previously suffered valvular disease (12) or had a valvular prosthesis (3); one patient had had a previous infective endocarditis. The infective episode involved the aortic valve in 26 patients, both the aortic and mitral valves in 18 patients, the mitral valve only in six and other valves in three. Echocardiographic examination showed one or more vegetations in 44 patients. Cardiac failure was diagnosed in 35 patients and embolic episodes in 22, of whom 11 were cerebrovascular accidents. The patients became afebrile 19 +/- 39 days after starting antibiotic treatment. Valve replacement was performed in 37 patients during their initial hospitalization, and in four during follow-up. After a mean follow-up of 4.6 +/- 3.1 years with a 100% follow-up, 15 patients died: 1 preoperatively, one in the first 30 days after operation, 13 later (8141 operated patients and 5/12 non-operated patients). Actuarial survival was 73% at 5 years. Gastrointestinal signs were present in 12 patients; 43 patients (81%) had a full colonic examination which showed polyps in 20 patients and adenocarcinomas in seven. Of 11 late deaths four were related to a malignant colonic tumour. This study confirms that Streptococcus bövis infective endocarditis is 'relatively benign', but it stresses the frequency and potential severity of the associated colonic lesions, requiring colonoscopy and making the treatment of high risk lesions mandatory.

Objective: To update data on incidence and characteristics of infective endocarditis in France., Background: Numerous studies have shown that the incidence and course of infective endocarditis remain stable in spite of advances in treatment and of prophylactic recommendations., Methods: A survey of all consecutive cases of infective endocarditis was conducted over 12 months in all the institutions of three French regions., Results: Data were collected from 415 cases of definite (32%), probable (53%), and possible (15%) infective endocarditis. The adjusted annual incidence was 24.3 cases per million inhabitants. Thirty-four percent of the patients had no previously known heart disease, 33% had native valve disease, 22% had a prosthetic valve, and 11% had miscellaneous underlying conditions. Infective endocarditis was located solely on the mitral valve in 39%, solely on the aortic valve in 36%, and on the tricuspid valve in 6%. Echocardiography showed a vegetation on the mitral valve in 39%, on the aortic valve in 29%, and on the tricuspid valve in 8%. The causal microorganism was identified in 92%; it was a Streptococcus in 58%, and a Staphylococcus in 23%. Twenty patients were intravenous drug users, and 45 had had a medical or a surgical procedure, which might be associated with the occurrence of infective endocarditis. During the first 2 months after admission, 24% of the patients underwent surgery, and 17% of all patients died., Conclusions: Despite medical and surgical advances, infective endocarditis remains frequent and severe in France.

The epidemiological characteristics of infective endocarditis in France were established in a one-year survey of strictly defined cases. The incidence of the disease is 18 cases per year and per million inhabitants, i.e. 970 cases annually. Patients are generally treated in Teaching Hospitals (80% of the cases were at the end of the hospitalization period). The predominant pathogens are the streptococci non groupable in 40.4% of the cases (group D in 21.9%) and the staphylococci (20.8%). Patients with group D streptococci endocarditis are the older ones (mean age: 60 years). Staphylococcal endocarditis occurs in younger patients (mean age: 43 years), especially after cardiac valve prosthesis or unrecognized cardiac valve disease, and it is the most serious form, with a 45% mortality rate (overall mortality rate: 21%). One quarter of the patients undergo a surgical operation.